Explain how ethics can impact payer mix and reimbursement.The module will also cover a brief history of claims processing and discusses form completion and governmental payers.
Welcome to Week 3
Posted on: Monday, November 7, 2016 12:00:00 AM EST

In this week’s module we will learn:

Module Three (3) examines claims processing and the appeals process. The module will also cover a brief history of claims processing and discusses form completion and governmental payers.

Module Objectives:

Examine third-party policies to determine payer-mix and reimbursement.
Assess claims processing and the appeals process to achieve timely reimbursement.
Evaluate governmental payer types for compliance with rules and regulations.

Please make sure to read the Module 3 Lecture and associated textbook readings listed in Module 3. This information will help you when developing your Discussion Board 3 posting. You will need to substantiate your answers to the Discussion Board 3 questions. Remember to use correct APA formatting when citing sources.

What is due this week:

Discussion Board Post for Module 3

This week’s topic. Make sure you address each question

In your post, compare and contrast various payers and suppliers and the claims filing process. Who are the main payers (i.e. insurance companies) within our healthcare industry? Make sure you compare and contrast these payers. Make sure you talk about the claim filing process. What type of claim form is submitted by a hospital? What types of claim form is submitted by a professional provider?
How important are ethics with claims processing? Please make sure to include information on ethics and why it is important for providers/facilities to be compliant with the claims filing process. Students have missed this piece in previous courses.
Explain how ethics can impact payer mix and reimbursement. Take the payer mix you compared and contrast in the first bullet to help answer this question. Ask yourself…Why should a payer/insurance company be ethical? What is the impact to providers if the payer/insurance company does not follow a certain standard?
In response to your peers, support their position with additional ideas and concepts from the module’s readings. Offer a potential problem that could arise when dealing with claims filing.

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